Insurance - Jaycox - 1977-01-31 II f 1 In \ •
=e„ ,rye�
u "rtvee,-i- JAN 31 2 30 PM '77
3200 WILSHIRE BOULEVARD (213) 301 31
LOS ANGELES. CALIFORNIA 90010
This is to certify that the. folio' ing policyls), subject to the terms, conditions, limitations and endorsements conta ned therein, and during the,
effecti p iod, have beer slued by the company(s) indicated below In the event of material change or cancellation of said polic •sl, the com-
mny ill endeavor to notify the certificate holder but fcilure to do so shall impose no liability or obligation of any kind upon tha undersigned
or the company(s) invol' ed.
CEP ,CHTE CERTIFICATE
SUED TO
Costa Mesa Sanitary District of Orange County OF
77 Fair Drive
Costa Mesa , California INSURANCE
YSUED Jaycox Sanitary Service
Jaycox Disposal Service of Costa Mesa, Inc „ )1102t.1016 East patella Avenue BY ”N
Anaheim, California
TYPE OF POLICY Co NSUPOLICY NOAPANY POLICY PERIOD LIMITS OF LIABILITY
WORKMEN'S COMPENSATION Argonaut 3-14 76 STATUTORY IN CONFORMANCE WITH THE COMPENSATION
& EMPLOYER'S LIABILITY * 332 88010 3 14 77 LAW OF THE STATE OF CALIFORNIA 4
GENERA. LI'UNITY BODILY INTUIT(
SP.E..S_>OPERATIONS ACH PERSO!
INDEPE" DEng CONTRACTOR`
/SS EACH OCCUPRI
PROWR conPLETED OPLRA IONS '� Al l i an z 1-31-7 7 s AGCnEGArE PRGG as-
NIA, El CO:ITPACTUAL * GLA S O 0 012 1 31 7 8 COMPL TED OPERA 'OHS
GENEPA' LEA'iLITt-PROPERTY DAMAGE *
PRE,.,.:_. CPERA110:05 E'CH OCaURTE:
UIGEP :DENT CONTRACTOR *
S AGGREGATE
PDO3UCTS.COT 'METED OPERATIONS S 300 ,000 COMBl LED ST :GL iT 1Q
a
EL- H CONIPA .UAL •• ____
AUTON,03'LE LIABILITY BODILY INJURY *
Ai.,C',:CBN ES CH SON
1.0: J ,r;EDAL,IOMOCILES Allianz 1 31 77 occuP
'.UTOrHOEr'c LIAuLay_PRaPERrY DNIAGE * GLA500012 ( 1-31 78
Od,. ..JIV, GENES ) l 5 ..CH OCCLOPE
NOT -O' ED AUTO'•.OBLES " 5 'nn, nnn CC '.IA ED$! 1GT_- IT _^
PHYSICAL-D:0+AG"E S
AC;UA C-Sn
EFT ST IE AMOUNT Or O;l DEDUCIBLE OP.
Umbrella Liability Chicago 7 15 76 $2 , 500 ,000 Combined Single
2250030309 7 15 77 Limit - Bodily Injury and
Property Damage
Her ve any loss under Physical Damage coverage is payable as interests may appear to the named ins 'red
and the Li Holder named below in accordance with Loss Payable Endorsement on reverse side.
LI ENHO COER
as respect: It is understood and agreed , that COSTA MESA SANITARY DISTRICT OF
ORANGE COUNTY is included as an additional insured but only as
respects the operation of the named insured for the Costa Mesa 4
Sanitary District of Orange County
APPLICABLE ONLY WHEN COMPLETED BY INSERTION OF THE NUMBER OF BAYS
In the e It of material range or car cellotion of said policy(s), the company(s) ag to give_ l0 days wr :en notice to
the certificate holder
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JAN 31 2 30PH '77
PACIFIC EMPLOYERS INSURANCE COMPANY
A MEMBER OF
PACIFIC EMPLOYERS GROUP t p,EG' OF INSURANCE COMPANIES
HOME OFFICE LOS ANGELES
CONTRACT PERFORMANCE BOND ON PUBLIC WORK Bond No. H _ Xa\ 16 74 85
KNOW ALL MEN BY THESE PRESENTS, That
Jaycox Disposal Service Of Costa Mesa Inc
as Principal, and PACIFIC EMPLOYERS INSURANCE COMPANY incorporated under the laws of the State of California,
as Surety, are held and firmly bound unto
Costa Mesa Sanitary District of Orange County
in the sum of
Twenty thousand and no/100 Dollars ($ 20 000 00 ),
for the payment whereof, well and truly to be made, said Principal and Surety bind themselves their heirs, admini-
strators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH THAT, whereas the above bounden Principal has entered
into a contract, dated February 1 1977 with the
Costa Mesa Sanitary District of Orange County
to do and perform the following work, to wit:
Furnish all labor material and equipment necessary collection of garbage
and rubbish within the boundaries of the Costa Mesa Sanitar• District for
the period of February 1 1977 to July 1 1979
NOW THEREFORE, if the above bounden Principal shall well and truly perform the work contracted to be performed
under said contract, then this obligation shall be void; otherwise to remain in full force and effect.
SIGNED, SEALED AND DATED this 27th day of January 1977
Jaycox Disposal Service of Costa Mesa„ Inc.
pay' • �
Principal
PACIFIC EMPLOYERS INSURANCE COMPANY
9
ohn Tn-ersoll f Attorney Fact
P511 101 3M 7-62
AUTOMOBILE LOSS PAYABLE 49 A
(CALIFORNIA ONLY)
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sts pr ided ele that de id by th Holde ore —
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